Name *

Cast or Crew? *

Date of Birth *

Address *

Phone number *

Unit or Troop *

Membership number (all Girlguiding members and Scouting members over 18)

Any special medical or educational needs or dietary requirements/allergies? (including medication held by a cast member during rehearsals) *

Please provide an emergency name and contact number *

Photo consent - I give High Wycombe Gang Show permission to take photographs and video of me/my child. I grant High Wycombe Gang Show full rights to use the images resulting from the photography/video filming and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group's aims. This might include (but is not limited to) the right to use them in their printed and online publicity, social media, press releases and funding applications. *

Code of conduct bit.ly/1Code_Of_Conduct and cast agreement bit.ly/Cast_Agreement *

I confirm that the information given in this form is true, complete and accurate. *